Overview

A digital weight loss intervention was implemented over a 12-month period in a primary care setting to see if provider counseling (usual care or intervention-specific) affects weight loss outcomes.

Organization Type

• Community health center
• FQHC

Tech Involved

• Electronic medical record
• Smartphone
• SMS
• Telephone
• Text messaging

Team Members Involved

• Dietician
• Health Coach
• Psychologist

Workflow Steps

• This digital health weight loss intervention included individualized behavioral goal setting, weekly telephone (texts or voice response calls) goal monitoring, skills training material, counseling calls, and individualized recommendations from providers.
  • Participant eligibility criteria included if they had a BMI between 30.0–44.9 kg/m2; weighed less than 330 lb (weight limit for digital scale used in the intervention); and if they had a diagnosis of diabetes, hyperlipidemia, or hypertension.
  • Behavior change goals were updated every two months and participants received calls from health coaches at least 18 times over the 12-month intervention.

Outcomes

• According to the participant report, the provider weight counseling was not associated with changes in weight during 0-6 months and 6-12 months. 
• According to provider documentation, counseling was associated with changes in weight during the entire 0-12 months.
  • Those who received intervention-specific counseling lost 4.0kg more weight than those who had no counseling.
  • Those who received intervention-specific counseling lost 3.1kg more than those who had general weight counseling.
• Patient perception of provider empathy was associated with more weight loss between 6-12 months.

Unique Challenges

• A limitation was that counseling groups were not randomly assigned so a causal relationship could not be determined for counseling and weight. 
  • Individuals who had intervention-specific counseling may have become more engaged in coaching call discussions or striving to fulfill behavior change goals. 
• Another limitation is that there was not verifiable data such as audio recordings or length of visit.
  • There may have been confounding factors such as a stronger bonds between certain providers and patients affecting the impact of provider counseling.
  • Participants may have remembered their clinic visit inaccurately .
  • Providers may have reported their counseling incorrectly.

Sources

• McVay, M., Steinberg, D., Askew, S., Bennett, G.G. Provider counseling and weight loss outcomes in a primary care-based digital obesity treatment. J Gen Intern Med. 2019;34(6):992-998.